Medicare can provide coverage for substance abuse treatment. Medicare pays for many substance abuse programs. Including inpatient rehab, outpatient counseling, and medication. Another, more intensive, outpatient option is a Partial Hospitalization Program. To qualify, the doctor must certify that you would otherwise have to be in an inpatient program.
Inpatient Medicare Coverage for Substance Abuse
Part A may cover the cost of the stay for an inpatient facility. Your doctor must write a recommendation for treatment and believe it to be necessary. You must pay Part A deductibles, copayments, or coinsurance amounts that may apply. Also, any inpatient medications for treatment may have coverage by Part A.
Medicare covers the Partial Hospitalization Program (PHP) for substance abuse treatment. Your doctor must certify that you need twenty hours or more of therapeutic services weekly. Then, your doctor must submit a plan for treatment and recertify your needs.
Outpatient Medicare Coverage for Substance Abuse
Outpatient counseling falls under Part B. Counseling for substance abuse, and mental illnesses have coverage. Medicare requires counseling to be in the doctor’s office, a hospital outpatient setting, or a mental health center. Part B covers medicines that are given to you by a doctor, meaning they can’t be self-administered. Part B outpatient drugs that treat substance abuse and addiction have different criteria. Ask your doctor any questions about treatment.
Medicare Advantage Coverage for Substance Abuse
Those with Medicare Advantage coverage have access to substance abuse treatment. But, it’s essential to use an in-network doctor. Otherwise, you pay ALL costs. Some Special Needs Plans help people with specific chronic issues such as mental health or substance abuse. Options for plans vary by county.
Contact your health plan to find an in-network specialist. You can also call an agent at the number above to discuss plan options.
Part D and Substance Abuse Medications
Prescriptions are only covered if you have a separate Part D plan. Part D covers prescription substance abuse medications that you take at home. Each Part D plan has a schedule of covered drugs and their cost. Coverage for a specific medication depends on your policy and whether you use one of the plan’s preferred pharmacies.
Does Medicare cover drug rehab?
Medicare’s substance abuse treatment coverage includes rehab for all types of drug addiction. Coverage extends to those with illegal drug addiction, alcohol addiction, and addiction to prescription drugs.
How long does Medicare pay for rehab?
Part A pays the full cost of 60 days of inpatient rehab in a semi-private room. For days 61 to 90, it costs you $352 coinsurance each day. After the 90th day, the coinsurance amount doubles, and you begin using lifetime reserve days. Medicare only allows 60 of these during your lifetime. If you’ve been an inpatient for over 90 days and you don’t have lifetime reserve days, Medicare won’t pay for care.
A supplement plan can extend the number of days you have hospitalization coverage. If you get inpatient care at a psychiatric hospital, Medicare covers 190 days of lifetime care.
The limit on lifetime days is a problem if you need intensive mental health services or suffer a relapse. But the limitation doesn’t apply to care in a general hospital. For most people in rehab, an inpatient stay is the beginning of the journey. After discharge, Part B will continue to pay for counseling and medical care needed to stay on track.
Does Medicare cover opioid treatment?
An estimated 300,000 Medicare patients had an opioid addiction. Medicare covers treatment for opioid addiction in a hospital or doctor’s office in the same as other treatments. Part B coverage extends to opioid treatment programs and methadone clinics that enroll in Medicare. Coverage includes telehealth services as well as in-person services.
Does Medicare cover Methadone treatment?
Methadone is the oldest and best-known opioid treatment. If administered to an inpatient at a hospital, Part A covers methadone. For people who are not inpatients, methadone is a highly-controlled prescription drug that you can’t get at a regular pharmacy. Patients must go to an opioid treatment center for daily doses of methadone. Medicare covers methadone and other opioid treatment services that enroll in Medicare.
Does Medicare cover substance abuse counseling?
Part A covers substance abuse counseling while you are an inpatient. Part B includes substance abuse counseling when a mental health doctor provides care. Mental health professionals include psychiatrists, psychologists, and licensed clinical social workers. Medicare pays for individual or group sessions. But it doesn’t pay for support groups, peer counseling, or other informal counseling. Medicare will also pay for telehealth counseling as part of an opioid treatment program.
Does Medicare cover addiction treatment?
Overcoming a severe addiction may mean months in inpatient rehab and years of outpatient therapy. Often, people with addictions struggle with mental health issues. Medicare covers addiction treatment, but you may pay deductibles, copays, and coinsurance. Those with a Medigap plan will pay less out of pocket than those with Medicare.
How to Get Supplemental Medicare Coverage for Substance Abuse Treatment
Substance abuse treatment can be a long and challenging road, and the costs can add up. A supplement plan can make these costs manageable by picking up cost-sharing. An agent is a professional that can answer your questions and compare all options in your area. Let them find a policy for you; this saves you time and money. Give us a call at the number above or fill out our online rate comparison form for a free quote on policies in your area.